Active NPI
Graceful Care Home Health Services Inc.
- Home Health Agency
- Anaheim, CA
National Provider Identifier
1083329957
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Home Health Agency
- Legal business name
- GRACEFUL CARE HOME HEALTH SERVICES INC.
- Practice address
- 1775 E Lincoln Ave Ste 203
Anaheim, CA 92805-4324 - Phone
- (714) 860-4425
- NPI assigned
- Jan 16, 2023
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Jade Hanson
- Title
- Complaence Officer
- Phone
- (916) 934-4913
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Home Health Agency | 251E00000X | Primary |
Addresses
Primary practice location
1775 E Lincoln Ave Ste 203
Anaheim, CA 92805-4324
Mailing address
1775 E Lincoln Ave Ste 203
Anaheim, CA 92805-4324
Other names 1
- Graceful Care Home Health Services Inc.
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20240415003100 | CA | Part A Provider - Home Health Agency | 4183063837 | Practice locations: Anaheim, CA |
Home health agency certification: CCN 757902
- Legal name
- GRACEFUL CARE HOME HEALTH SERVICES INC
- Certification status
- Active
- Provider type (POS)
- Home health agency
- Participating since
- Feb 18, 2025
- Last certification
- Feb 6, 2025
- Organization structure
- Corporation
- Incorporated
- May 16, 2022 in CA
- Enrollment address
- 1775 E Lincoln Ave
Ste 203
Anaheim, CA 92805-4324
Care Compare: Home health agency
Medicare Care Compare- Listed as
- Graceful Care Home Health Services Inc.
- Ownership
- -
- Certified
- Feb 18, 2025
- Medicare certification status
- Active
National Provider Directory
National Provider DirectoryLocations
1775 E Lincoln Ave
Ste 203A
Anaheim, CA 92805
Phone (714) 699-2911
Ownership & related parties
All disclosed owners & managing parties 1
As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.
| Name | Role | Since | Share |
|---|---|---|---|
| Basil Issa | 5% Or Greater Direct Ownership Interest | May 16, 2022 | 100% |
| Corporate Officer | May 16, 2022 | 100% | |
| W-2 Managing Employee | May 16, 2022 | 100% |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1673827200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1673827200000",
"number": "1083329957",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1775 E LINCOLN AVE STE 203",
"city": "ANAHEIM",
"state": "CA",
"postal_code": "928054324"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1775 E LINCOLN AVE STE 203",
"city": "ANAHEIM",
"state": "CA",
"postal_code": "928054324",
"telephone_number": "714-860-4425"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "GRACEFUL CARE HOME HEALTH SERVICES INC.",
"organizational_subpart": "NO",
"enumeration_date": "2023-01-16",
"last_updated": "2023-01-16",
"certification_date": "2023-01-16",
"status": "A",
"authorized_official_last_name": "HANSON",
"authorized_official_first_name": "JADE",
"authorized_official_title_or_position": "COMPLAENCE OFFICER",
"authorized_official_telephone_number": "916-934-4913"
},
"taxonomies": [
{
"code": "251E00000X",
"taxonomy_group": "",
"desc": "Home Health",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "Graceful Care Home Health Services Inc.",
"code": "3",
"type": "Doing Business As"
}
]
}
Other providers in Anaheim, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 16, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; facility enrollments, owners and changes of ownership; Provider of Services certification data.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.